Presentation Outline ICHP Annual Meeting September 13-15

Residency Project Pearls
Extended Stability of Intravenous
Acetaminophen in Syringes and Opened
Glass Bottles
JJennifer if L. L Kwiatkowski, K i k ki Ph Pharm.D. D
Pediatric Specialist at St. John’s Hospital, Springfield, IL
September 2012
Great Lakes Presentation from PGY2 Pediatric Pharmacy
Residency at the University of Michigan
The speaker has no actual or potential conflict of interest in relation to this presentation.
Drug Development
• Intravenous acetaminophen approved for use
in Europe in 2001
• Marketed in over 80 countries
• Food and Drug Administration (FDA) approved
in November 2010
Jahr JS et al. Anesthesiol Clin. 2010;28(4):619‐45.
Aqueous Decomposition
Acetaminophen
p‐aminophenol and acetic acid
Koshy KT et al. J Pharm Sci. 1961;50:113‐8.
Menezes HA et al. J Electroanal Chem. 2006; 586(1):39‐48.
Hydrolysis
Oxidation
p‐benzoquinoneime
Hydrolysis
p‐benzoquinone
Therapeutic Uses
• Unable to tolerate oral or rectal drug
administration
• Potential reduction in opioid or NSAID related
adverse effects
• Insufficient response to IV opioids or NSAIDs
• Contraindication to IV NSAIDs
Babl FE et al. Pediatr Emerg Care. 2011;27(6):496‐9.
Product Formulation
• Limited water solubility
– Higher at room temperature compared to
refrigeration
• Stability in aqueous solution
Martindale 35th ed. 2007.
Koshy KT et al. J Pharm Sci. 1961;50:113‐8.
Influence of pH
• Target pH 5‐6
– Reported half life 19‐22 years
• Acidic environment
– Reported p half life